Necrotizing Enterocolitis and Your Protections Under the Law

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What is Necrotizing Enterocolitis (NEC)?

Necrotizing enterocolitis is a devastating intestinal disease that mainly affects premature babies. The walls of the intestine are invaded by bacteria which cause local infection and inflammation that can ultimately destroy the walls of the intestine. If holes develop in the walls of the intestine, spillage of stool into the abdomen can cause an overwhelming infection and lead to multiple different types of injuries including brain damage and death. If you’re child has suffered from this preventable disease contact a medical malpractice lawyer Belleville, IL.

How often does Necrotizing Enterocolitis occur?

NEC occurs in approximately 10% of premature infants. It is the most common and serious intestinal disease among premature babies. There are an estimated 9,000 cases of NEC per year.

What are the Signs & Symptoms of NEC:

The symptoms of NEC can mimic a lot of other intestinal problems. Typically, NEC can be diagnosed via X-ray or surgical exploration. An abnormal gas pattern on the X-ray is how NEC is diagnosed non-operatively.

• a swollen, red, or tender belly
• trouble feeding
• food staying in the stomach longer than expected
• constipation
• diarrhea and/or dark or bloody stools (poop)
• being less active or lethargic
• a low or unstable body temperature
• green vomit (containing bile)
• apnea (pauses in breathing)
• bradycardia (slowed heart rate)
• hypotension (low blood pressure)

What Causes Necrotizing Enterocolitis (NEC):

It is not possible in every case to say that something conclusively caused NEC. However, there are many causes can lead a baby to develop NEC.

• an underdeveloped (premature) intestine
• too little oxygen or blood flow to the intestine at birth or later
• injury to the intestinal lining
• heavy growth of bacteria in the intestine that erodes the intestinal wall
• viral or bacterial infection of the intestine
• formula feeding (breastfed babies have a lower risk of NEC)

There is a preventable cause of NEC, which is avoiding formula feeding and human milk fortifiers.

Who Gets Necrotizing Enterocolitis (NEC)?

Typically, NEC is seen in babies born before 32 weeks of gestation and who are low birth weight. It usually develops within 2-4 weeks of being born.

How Is Necrotizing Enterocolitis Treated?

After diagnosis, treatment begins immediately. It includes:

• temporarily stopping all feedings
• nasogastric or orogastric drainage (inserting a tube through the nose or mouth into the stomach to remove air and fluid from the stomach and intestine)
• IV (given into a vein) fluids for fluid replacement and nutrition
• antibiotics to treat or prevent infection · frequent exams and abdominal X-rays
• a consultation with a pediatric surgeon to discuss surgery, if needed
• in severe cases, surgery may be needed right away

The baby’s poop is watched for blood and the baby’s belly size is checked regularly. A hole in the intestine or an infection in the abdominal cavity will make the belly swell. If a baby’s belly is so swollen that it affects breathing, extra oxygen or a breathing machine (ventilator) will help the baby breathe. Also, blood tests will look for bacteria and check for anemia (a decrease in red blood cells).

After responding to treatment, a baby can be back on regular feedings after a week or two. When feedings start again, breast milk is recommended. Breast milk is beneficial for babies with NEC because it is easily digested, supports the growth of healthy bacteria in the intestinal tract, and boosts a baby’s immunity — which is especially important for a preterm baby with an immature immune system.

For women who can’t breastfeed or provide enough breast milk, doctors may recommend giving the baby pasteurized human breast milk from a milk bank, which is considered a safe alternative. Special formula may also be used.

Some babies will need surgery if their condition gets worse despite medical care. The surgeon will look for a hole in the intestine and remove any dead or dying intestinal tissue. In some cases after this removal, the healthy intestine can be sewn back together. Other times, especially if the baby is very ill or a large section of the intestine was removed, an ostomy is done. During an ostomy, surgeons bring an area of the intestine to an opening on the abdomen (stoma) so that stool can safely exit the body. A second surgery may be done to re-examine the intestines. If an ostomy is made, it will be closed 6–8 weeks later, after the intestine is fully healed and healthy again.

What causes NEC from formula?

When babies are born premature and especially under 3.3 lbs, nutrition is extremely important. The goal of the medical staff will be to get the baby to gain weight. The best and safest way to do this is to use mother’s own milk. Sometimes, mother’s milk may not be available. And sometimes, the medical staff may want the baby to put on more weight so they will want to add what are called fortifiers to the milk. Fortifiers are added calories to help the baby gain weight. The fortifiers used are often made from cow milk not human milk. These are known as bovine based fortifiers. Babies that are fed anything other than mother’s milk, or other human milk products, are at a much greater risk for developing NEC.

As far back as 1990, a study of 926 preterm infants found that NEC was 6 to 10 times more common in formula fed babies than in those fed breast milk alone and NEC was 3 times more common in babies fed formula plus breast milk.

A study from 2009 showed that babies who were fed an exclusively human-milk based diet, whether it was mother’s milk, donor milk or other human products were 90% less likely to develop NEC as compare to a diet that contained some bovine milk products.

In 2012, the American Academy of Pediatrics issued a policy statement that all premature infants should be fed an exclusive human milk diet because of the risk of NEC associated with the consumption of cow’s milk products.

A 2013 study showed that babies fed exclusively human milk met all growth targets which undercut the justification for using bovine milk products.

Why wasn’t I told about the dangers of formula or human milk fortifiers?

The companies that manufacture these bovine based products do not include any warnings on them for doctors or patients. They are marketed as equally safe to breast milk and are marketed as necessary to help achieve growth.

What can I do about my baby’s Necrotizing Enterocolitis?

Call us: (618) 239-6070 We will review your baby’s medical records to determine if they received one of these bovine milk based fortifiers. We will also determine whether there might be other reasons for the NEC your baby developed. Once we have reviewed the records, we can discuss with you whether or not you may have a claim.